Chiu Sung-Hua, Kesselman Andrew, Yoon Luke, Kamaya Aya, Tse Justin R
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Room H-1307, Stanford, CA 94305.
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, Taiwan.
AJR Am J Roentgenol. 2025 Apr 30. doi: 10.2214/AJR.25.32745.
LI-RADS CT/MRI Radiation Treatment Response Algorithm (TRA) version 2024 (v2024) addresses a pitfall of the earlier algorithm relating to expected persistent enhancement of hepatocellular carcinoma (HCC) responding to radiation. v2024 removes LR-TR Equivocal, introduces LR-TR Nonprogressing (stable or decreasing masslike enhancement), and more narrowly defines LR-TR Viable (new or increasing masslike enhancement). To evaluate in patients with HCC treated by Y-90 radioembolization the redistribution of categories in LI-RADS CT/MRI Radiation TRA v2024 versus LI-RADS CT/MRI TRA version 2018 (v2018) and to assess short-term outcomes of v2024 categories. This retrospective study included 242 patients (57 women, 185 men; median age, 65 years) with 319 HCCs treated by Y-90 radioembolization from February 2011 to March 2022 and evaluated by initial 3-month posttreatment CT or MRI. Two radiologists assigned v2018 and v2024 categories; a third radiologist resolved discrepancies. The radiologists also assessed available second posttreatment CT or MRI examinations using v2024. Overall survival (OS) was determined. On initial follow-up, by v2018, 18 (5.6%) lesions were LR-TR Nonviable, 21 (6.6%) LR-TR Equivocal, and 280 (87.8%) LR-TR Viable; by v2024, 18 (5.6%) were LR-TR Nonviable, 182 (57.1%) LR-TR Nonprogressing, and 119 (37.3%) LR-TR Viable. All LR-TR Equivocal and 161 (57.5%) LR-TR Viable lesions by v2018 were recategorized as LRTR Nonprogressing by v2024. Of 96 LR-TR Nonprogressing lesions with second follow-up, 63 (65.6%) remained LRTR Nonprogressing, 19 (19.8%) transitioned to LR-TR Nonviable, and 14 (14.6%) transitioned to LR-TR Viable. Of 29 LR-TR Viable lesions by v2024 with second follow-up, 23 (79.3%) remained LR-TR Viable, and 6 (20.7%) transitioned to LR-TR Nonprogressing. By Kaplan-Meier analysis using initial categories, OS showed no significant difference between LR-TR Equivocal and LR-TR Viable for v2018 (p=.05) but was significantly worse for LR-TR Viable than LRTR Nonprogressing for v2024 (p<.001). For v2024, LR-TR Viable was substantially less frequent versus v2018, and the majority of lesions were assigned LR-TR Nonprogressing. Using v2024, most LR-TR Viable lesions and the majority of LR-TR Nonprogressing lesion on initial follow-up remained as such on later imaging. Initial v2024 categories were associated with OS. The findings support the revisions in v2024.
肝脏影像报告和数据系统（LI-RADS）CT/MRI放射治疗反应算法（TRA）2024版（v2024）解决了早期算法中与对放射治疗有反应的肝细胞癌（HCC）预期持续强化相关的一个缺陷。v2024版删除了LR-TR equivocal，引入了LR-TR非进展型（稳定或递减的类肿块强化），并更狭义地定义了LR-TR存活型（新出现或增加的类肿块强化）。为了评估接受钇-90放射性栓塞治疗的HCC患者中，LI-RADS CT/MRI放射治疗TRA v2024版与LI-RADS CT/MRI TRA 2018版（v2018）中分类的重新分布情况，并评估v2024版分类的短期结果。这项回顾性研究纳入了2011年2月至2022年3月期间接受钇-90放射性栓塞治疗并通过首次治疗后3个月的CT或MRI进行评估的242例患者（57例女性，185例男性；中位年龄65岁），共319个HCC。两名放射科医生指定v2018和v2024版的分类；第三名放射科医生解决分歧。放射科医生还使用v2024版评估了可用的第二次治疗后CT或MRI检查。确定了总生存期（OS）。在首次随访时，根据v2018版，18个（5.6%）病灶为LR-TR无活性，21个（6.6%）为LR-TR equivocal，280个（87.8%）为LR-TR存活型；根据v2024版，18个（5.6%）为LR-TR无活性，182个（57.1%）为LR-TR非进展型，119个（37.3%）为LR-TR存活型。v2018版中所有LR-TR equivocal和所有161个（57.5%）LR-TR存活型病灶在v2024版中被重新分类为LR-TR非进展型。在96个进行了第二次随访的LR-TR非进展型病灶中，63个（65.6%）仍为LR-TR非进展型，19个（19.8%）转变为LR-TR无活性，14个（14.6%）转变为LR-TR存活型。在v2024版中有第二次随访的29个LR-TR存活型病灶中，23个（79.3%）仍为LR-TR存活型，6个（
